Esophageal Hiatal Hernia Repair Research Articles

Clinical effects of robot-assisted esophageal hiatal hernia repair and laparoscopic esophageal hiatal hernia repair: a retrospective comparative study

Objective: To analyze the short-term clinical effects of robot-assisted and laparoscopic repair of the hiatal hernia. Methods: The clinical data of 56 patients underwent minimally invasive hiatal hernia repair from January 2021 to January 2022 in the Department of Minimally Invasive Surgery, Hernias and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region were retrospectively analyzed. There were 32 males and 24 females, aging (59.7±10.7) years (range: 28 to 75 years). All patients were divided into laparoscopy group (n=27) and robot group (n=29) according to surgical procedures. Perioperative conditions, hospital stay, and improvement in symptoms before and after surgery were compared between the two groups by the t test, Wilcoxon rank-sum test and χ2 test. Results: All surgical procedures were successfully completed, without conversion to laparotomy or change in operation mode. There were no serious complications related to the operation. The intraoperative blood loss of the robot group was less than that of the laparoscopic group (M (IQR)): (20 (110) ml vs. 40 (80) ml, Z=-4.098, P<0.01). The operation time ((111.7±33.6) minutes vs. (120.4±35.0) minutes, t=-0.943, P=0.350) and hospitalization time ((3.9±1.4) days vs. (4.7±1.9) days, t=-1.980, P=0.053) of the robot group and the laparoscopic group were similar. Follow-up for 12 months after the operation showed no postoperative complications and recurrence. The score of the health-related quality of life questionnaire for gastroesophageal reflux disease in the robot group decreased from 10.8±2.8 before the operation to 6.5±0.6 after the operation, and that in the laparoscopic group decreased from 10.6±2.1 before the operation to 6.3±0.6 after the operation. There was no difference in the influence of different surgical methods on the change in score (t=0.030,P=0.976). Conclusion: Compared with laparoscopic repair of the hiatal hernia, robot-assisted hiatal hernia repair has the advantages of less bleeding, rapid postoperative recovery and good short-term effect.

Application of an Extracorporeal-Assisted Intracorporeal Sliding Knot-Tying Technique in Minimally Invasive Surgery in Children.

Background: A retrospective study was carried out to determine the feasibility and safety of an extracorporeal-assisted intracorporeal sliding knot-tying technique in minimally invasive surgery in children. Materials and Methods: From June 2009 to December 2017, a total of 333 cases of pediatric minimally invasive surgery were performed using the extracorporeal-assisted intracorporeal sliding knot-tying technique. Polyester, polyglactin, and polydioxanone sutures were used for suturing and knotting. The average time used for knotting was recorded during the surgery. The patients were followed up for unraveled knots and recurrence of the diseases. Results: All 333 surgical procedures were performed successfully, including 152 cases of thoracoscopic diaphragmatic hernia repair, 151 cases of thoracoscopic diaphragmatic plication, 7 cases of thoracoscopic esophageal anastomosis, and 23 cases of laparoscopic esophageal hiatal hernia fundoplication. No serious complications or mortalities were observed. Twelve-month to 9-year follow-up showed that all pediatric patients recovered well and no recurrence or unraveled knots were found. Conclusions: This new knot-tying technique is safe and feasible for various minimally invasive endoscopic surgeries, especially for suturing tissues under tension, such as thoracoscopic diaphragmatic hernia repair, laparoscopic esophageal hiatal hernia repair, and fundoplication. All types of sutures can be used for this knot-tying technique. It is easy to learn and can be quickly mastered by doctors with endoscopic surgery experience.

Clinical efficacy of laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett′s esophagus

Objective To investigate the clinical efficacy of laparoscopic fundoplication for gastro-esophageal reflux disease complicated with Barrett′s esophagus. Methods The retrospective cross-sectional study was conducted. The clinicopathological data of 12 patients with gastroesophageal reflux disease complicated with Barrett′s esophagus who were admitted to Beijing Chao-Yang Hospital of Capital Medical University between July 2012 to July 2016 were collected. Preoperative tests of patients included distal esophageal manometry and 24-hour pH monitoring, gastroscopy and upper gastroenterography. According to preoperative evaluation of patients, laparoscopic Nissen fundoplication was preferred, and laparoscopic Dor fundoplication was used for patients with discordant esophageal peristalsis function. Observation indicators: (1) surgical and postoperative recovery situations; (2) follow-up: ① subjective changes of reflux symptoms; ② distal esophageal manometry and 24-hour pH monitoring after operation; ③ progression of esophageal mucosal lesions. Patients were followed up using outpatient examination and telephone interview with questionnaire at one month after operation and gastroscopy every 6 months up to June 2018. Measurement data with normal distribution were represented as ±s and measurement data with skewed distribution were described as M (range). Results (1) Surgical and postoperative recovery situations: of 12 patients, 7 underwent laparoscopic Nissen fundoplication and 5 underwent laparoscopic Dor fundoplication. Seven patients complicated with esophageal hiatal hernia underwent laparoscopic repair of esophageal hiatal hernia, without conversion to open surgery. Operation time, volume of intraoperative blood loss and duration of hospital stay were (98±21)minutes, (27±13)mL, (2.3±1.2)days. There were no intraoperative and postoperative severe complications in the 12 patients. (2) Follow-up: 12 patients were followed up for 20-42 months with a average time of 32 months. ① Subjective changes of reflux symptoms: 12 patients completed questionnaires at one month after operation. Scores of heartburn in the 12 patients were 0. Acid regurgitation in the 12 patients was relieved, requiring no acid-inhibitory drugs. Upper abdominal dull pain in 3/4 of the patients and retrosternal pain in 2 patients were relieved. Patients had mild dysphagia or abdominal distention at 2 weeks after operation and recovered to normal diet by dietary instruction within 4 weeks. Score of dysphagia was 2 (range, 0-4) and no patient need hospitalization or surgical treatment. Score of surgery satisfaction was 9 (range, 7-10) in the patients. ② Distal esophageal manometry and 24-hour pH monitoring after operation: lower esophageal sphincter pressure and DeMeester score were (12.8±2.8)mmHg (1 mmHg=0.133 kPa) and 11±3 respectively. ③ Progression of esophageal mucosal lesions: 2 of 9 patients with short Barrett′s esophagus were detected complete regression of esophageal mucosal lesions at postoperative one year, 1 was detected partial regression of esophageal mucosal lesions at postoperative one year and 6 were detected no change at postoperative 2 years. One of 3 patients with long Barrett′s esophagus was detected partial regression of esophageal mucosal lesions at postoperative one year and 2 complicated with mild poor differentiation were detected no change at postoperative 2 years. Conclusion Laparoscopic fundoplication for gastroesophageal reflux disease complicated with Barrett′s esophagus can improve subjective symptom and objective markers of patients and provide satisfactory efficacy. Key words: Barrett′s esophagus; Gastroesophageal reflux disease; Anti-reflux surgery; Fundoplication; Laparoscopy; Efficacy

Laparoscopic Repair of Esophageal Hiatal Hernia with Cholestasis Secondary to Pancreatic Prolapse

Laparoscopic Repair of Esophageal Hiatal Hernia with Cholestasis Secondary to Pancreatic Prolapse

Laparoscopic anterior gastropexy for type III/IV hiatal hernia in elderly patients

IntroductionLarge esophageal hiatal hernias occur most commonly in elderly patients with comorbidities, in whom even an elective surgery cannot be performed without high risks. Although fundoplication is recommended for esophageal hiatal hernia repair, we prefer not to limit our options to fundoplication, as obstruction is a frequent main complaint. We favor an anterior gastropexy approach instead to perform anti-reflux surgery and prevent recurrent protrusion and torsion of the incarcerated organ with minimal risk. The aim was to evaluate the safety and effectiveness of anterior gastropexy for large hiatal hernia in elderly patients with comorbidities.Case presentationWe retrospectively evaluated 8 patients who underwent laparoscopic anterior gastropexy for large hiatal hernia (type III or IV) since 2006. All patients were women with a median age of 82 years (range, 74–87 years). The major complaint was obstruction in all patients, with relatively mild reflux symptoms. They underwent successful laparoscopic surgery with no conversion to laparotomy.Fundoplication was performed in 4 cases. No perioperative complications occurred, and the main complaint resumed rapidly in all patients, without recurrence during postoperative follow-up of median 48 months (range, 5–77 months).ConclusionLaparoscopic anterior gastropexy is safe and effective and can be considered as one of the practical surgical options for large hiatal hernias in elderly patients, whom surgical intervention should be minimized due to their comorbidities.

Upside-down stomachが自然修復した食道裂孔ヘルニアの1例

Upside-down stomachが自然修復した食道裂孔ヘルニアの1例

Full incorporation of Strattice™ Reconstructive Tissue Matrix in a reinforced hiatal hernia repair: a case report

IntroductionA non-cross-linked porcine acellular dermal matrix was used to reinforce an esophageal hiatal hernia repair. A second surgery was required 11 months later to repair a slipped Nissen; this allowed for examination of the hiatal hernia repair and showed the graft to be well vascularized and fully incorporated.Case presentationA 71-year-old Caucasian woman presented with substernal burning and significant dysphagia. An upper gastrointestinal series revealed a type III complex paraesophageal hiatal hernia. She underwent laparoscopic surgery to repair a hiatal hernia that was reinforced with a xenograft (Strattice™ Reconstructive Tissue Matrix, LifeCell, Branchburg, NJ, USA) along with a Nissen fundoplication. A second surgery was required to repair a slipped Nissen; this allowed for examination of the hiatal repair and graft incorporation 11 months after the initial surgery.ConclusionIn this case, a porcine acellular dermal matrix was an effective tool to reinforce the crural hiatal hernia repair. The placement of the mesh and method of fixation are believed to be crucial to the success of the graft. It was found to be well vascularized 11 months after the original placement with no signs of erosion, stricture, or infection. Further studies and long-term follow-up are required to support the findings of this case report.

Strangulation of the stomach and the transverse colon following laparoscopic esophageal hiatal hernia repair.

The authors present a 32-year-old male patient with incarceration of a recurrent esophageal hiatal hernia after laparoscopic repair. A life-threatening strangulation of the stomach and the transverse colon occurred within a few days after the operation. Relapse of hiatal hernias amounts to almost half of early complications characteristic for the laparoscopic approach. General recommendations regarding surgical technique as well as perioperative care have been proposed in order to decrease the risk of relapse. Also, routine contrast radiology on the first or second day following the laparoscopic operation facilitates early diagnosis of relapse of hiatal hernia with emergent reoperation. This may result in decreased morbidity and improved overall outcome of the treatment.

Laparoscopic repair of esophageal hiatal hernia

This study was to appraise safety and feasibility of laparoscopic approach and investigate the clinical effects of laparoscopic tension-free repair of esophageal hiatal hernia using mesh. From August 2006 to July 2009, 24 patients with esophageal hiatal hernia underwent laparoscopic repair. Twenty-three patients received laparoscopic tension-free repair using mesh, at the same time, Toupet or Dor partial fundoplication was performed. One patient was converted to open surgery. The average operating time was 90 min (70-210 min) and the blood loss was between 10-110 mL. There was no death. The mean postoperative hospital stay was 5 days (3-30 days). During a follow-up period of 12-20 months (mean 15 months), there was no recurrence of the hernia, and no complication with use of mesh. The present study suggested that laparoscopic approach was secure and minimally invasive operation for esophageal hiatal hernia and the use of mesh could reduce recurrence rate.

Atrial Fibrillation during Repair of Esophageal Hiatal Hernia: A case report

Atrial Fibrillation during Repair of Esophageal Hiatal Hernia: A case report

Flap technic for repair of esophageal hiatal hernia

A modification of the operation consisting of reinforcement of the crura of the diaphragm with a pedunculated diaphragmatic flap to which the abdominal portion of the esophagus is affixed is described. The procedure secures the hernial ring properly and protects the patients from recurrence and gastroesophageal reflux. The abdominal segment of the esophagus sutured to the diaphragmatic flap maintains the sphincter of the cardia within the abdominal cavity. Of twenty-eight patients undergoing surgery, in eleven of them the repair was performed according to the reported technic. No recurrences were noted during a three year follow-up study.

Repair of experimental hiatal hernia in dogs.

THE SURGICAL repair of esophageal hiatal hernia is currently a controversial subject. During recent years various new operations have been suggested in an effort to overcome some of the deficiencies of existing techniques. The purpose of this study was to evaluate the effectiveness of some of these new procedures in restoring normal anatomy and gastroesophageal competence in the presence of a weakened inferior esophageal sphincter. Emphasis has been placed on objective data, particularly intraluminal pressures, and cinefluoroscopic observations. <h3>Methods</h3> Adult mongrel dogs weighing 8 to 14 kg (17.6 to 30.9 1b) were used in this study. The surgical procedures were carried out with aseptic technique. The animals were under general anesthesia (ether or sodium pentobarbital, 25 mg/kg body weight) and were artificially ventilated. They were fed milk 24 hours after operation, and their diet gradually progressed from canned meat to a normal kennel diet after one week. Postoperative evaluation was